Pain, Not Catastrophizing, Predicts Opioid Use

It’s not catastrophizing that predicts who will still take opioids months after surgery, it’s the severity of the original pain/injury/illness.

New research reported in The Journal of Pain shows the strongest predictive factors for prolonged opioid use after a traumatic musculoskeletal injury and surgery are pain severity and a poor sense of control over pain. The Journal of Pain is the peer-reviewed publication of the American Pain Society.

Previous research has shown that people who sustain traumatic injuries are at higher risk than the general population for using and abusing opioids.

Several studies have identified risk factors for persistent opioid use, such as a history of drug or alcohol abuse and taking medications for depression and anxiety.

However, the extent that acute post-surgical pain and chronic pain influence persistent opioid use is not clear.

Results of the study, which employed secondary data analysis, showed that 35 percent of 122 patients reported using a prescription opioid for pain relief four months following a traumatic musculoskeletal injury requiring surgery.

These patients had significantly greater pain severity and pain interference scores than patients who were not using opioids.

The study results support the hypothesis that initial in-hospital pain severity would predict use of prescription opioids four months after surgery.

The data strongly suggest that pain severity and poor sense of pain control, not psychological distress, are the main factors associated with prolonged opioid use following musculoskeletal trauma and surgery.

“Pain severity” usually implies a “poor sense of pain control” and both are pretty darn distressing. Many pain specialists these days choose to believe that this distress (which they call “catastrophizing”) is maintaining a patient’s chronic pain, forgetting that the pain is what started the distress in the first place.

Repeated studies point out the link between pre-operative opioid use and continued postoperative opioid use, making it sound like the opioids have such a strong addictive pull that, once started, few can ever stop even after their pain is “cured”.

The critical fact omitted (deliberately?) is this:

People were taking opioids before surgery because their pain was more severe than those not using opioids.

Then it’s not so surprising that they might need more pain relief after surgery as well.

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